Publications by authors named "Jisheng Zhu"

16 Publications

  • Page 1 of 1

Management of Primary Hepatopancreatobiliary and Ampulla Large Cell Neuroendocrine Carcinoma.

J Laparoendosc Adv Surg Tech A 2021 Oct 11. Epub 2021 Oct 11.

Department of General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.

Large cell neuroendocrine carcinoma (LCNEC) of the liver, gallbladder, pancreas, and ampulla is rare and usually arises in case reports, and thus to date, no studies have well described the treatment options and outcomes of those patients. The data of 108 patients diagnosed as hepatopancreatobiliary and ampulla LCNEC between 2004 and 2015 were retrieved from the surveillance, epidemiology, and final results. In the entire cohort, the median overall survival (OS) was 10 months. For nonmetastatic patients, the median OS was 32 months for surgery of the primary tumor alone ( = 17), 19 months for surgery of the primary tumor and adjuvant therapy ( = 19), and 1 month for nonsurgical treatment ( = 8). For metastatic patients, the median OS was 14 months for patients who received surgery of the primary tumor with and without adjuvant therapy ( = 16), 9 months for patients undergoing adjuvant treatment alone ( = 30), and 1 month for patients who had no treatment ( = 16). Multivariate analysis revealed that surgery of the primary tumor was an independent factor for improved survival. This disease offers a very poor prognosis despite aggressive treatment. Radical resection is the first choice for resectable tumors, whereas surgical resection of the primary tumor plus adjuvant therapy might represent a valid option for metastatic disease. However, further studies are needed to confirm this.
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http://dx.doi.org/10.1089/lap.2021.0482DOI Listing
October 2021

PRMT4 promotes hepatocellular carcinoma progression by activating AKT/mTOR signaling and indicates poor prognosis.

Int J Med Sci 2021 27;18(15):3588-3598. Epub 2021 Aug 27.

Department of General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, China.

: Protein arginine methyltransferase 4 (PRMT4) has been reported to play a role in several common cancers; however, the function and mechanism of PRMT4 in hepatocellular carcinoma (HCC) are not fully understood. This study aimed to investigate the role and mechanism of PRMT4 in the progression of HCC. PRMT4 expression and clinicopathological characteristics were investigated using an HCC tissue microarray (TMA) consisting of 140 patient samples analyzed by immunohistochemistry. CCK-8, crystal violet and Transwell assays were used to determine cell proliferation, colony formation, migration, and invasion of HCC cell lines in which PRMT4 was overexpressed or downregulated. The underlying mechanism of PRMT4 function was explored by Western blot assays. PRMT4 was highly expressed in HCC tumor tissues compared to adjacent nontumor tissues. PRMT4 expression was significantly associated with alpha-fetoprotein levels, tumor size, satellite nodules, and microvascular invasion. Patients with higher PRMT4 expression had a shorter survival time and higher recurrence rate. Functional studies demonstrated that PRMT4 overexpression promoted HCC cell proliferation, migration, and invasion , while knocking down PRMT4 inhibited these malignant behaviors. Additional results revealed that PRMT4 promoted the progression of HCC cells via activation of the AKT/mTOR signaling pathway. Furthermore, inhibition of the AKT/mTOR signaling by MK2206 or rapamycin significantly attenuated PRMT4-mediated malignant phenotypes. This study suggests that PRMT4 may promote the progression of HCC cells by activating the AKT/mTOR signaling pathway, which may be a valuable biomarker and potential target for HCC.
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http://dx.doi.org/10.7150/ijms.62467DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8436100PMC
August 2021

Comparison of Survival Outcomes of Chemotherapy Plus Surgery vs Chemotherapy Alone for Patients With Isolated Liver Metastases From Gallbladder Carcinoma.

Am Surg 2021 Aug 12:31348211038563. Epub 2021 Aug 12.

Department of General Surgery, 117970The First Affiliated Hospital of Nanchang University, Nanchang, China.

Background: Chemotherapy is the standard of treatment for metastatic gallbladder carcinoma (GBC). It is unclear whether chemotherapy plus surgery improves the survival outcomes of patients with isolated liver metastases from GBC. We aimed to investigate the survival benefits of chemotherapy plus surgery in GBC with isolated liver metastases compared to those of chemotherapy alone.

Methods: We identified 406 patients with isolated liver metastases from GBC who underwent chemotherapy alone or chemotherapy plus surgery between 2010 and 2015 from Surveillance, Epidemiology, and End Results. Patients were divided into 3 subgroups: group I, chemotherapy alone (n = 263); group II, chemotherapy combined with cholecystectomy (n = 116); and group III, chemotherapy combined with cholecystectomy plus hepatectomy (n = 27). The cancer-specific survival and overall survival were evaluated.

Results: Compared with group I, group II revealed a longer survival time (P < .001). In addition, the survival time of the group III was also prolonged (P < .001). Multivariate cox analysis showed that treatment strategy was an independent prognostic factor.

Conclusion: Chemotherapy combined with resection of the primary tumor plus or not plus resection of the metastatic lesions may be beneficial in GBC with isolated liver metastases.
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http://dx.doi.org/10.1177/00031348211038563DOI Listing
August 2021

Long non-coding RNA VCAN-AS1 promotes the malignant behaviors of breast cancer by regulating the miR-106a-5p-mediated STAT3/HIF-1α pathway.

Bioengineered 2021 12;12(1):5028-5044

Department of General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.

An accumulating number of studies have found that long noncoding RNAs (lncRNAs) participate in breast cancer (BC) development. LncRNA VCAN-AS1, a novel lncRNA, has been confirmed to regulate the progression of gastric cancer, while its role in BC is elusive. Here, our results illustrate that VCAN-AS1 is overexpressed in BC tissues and cells, while miR-106a-5p was downregulated and negatively correlated with VCAN-AS1. In addition, high VCAN-AS1 expression and low miR-106a-5p expression were closely correlated with poor overall survival in BC patients. Functional experiments confirmed that VCAN-AS1 overexpression notably accelerated BC cell proliferation, migration, invasion, and epithelial-mesenchymal transition (EMT) and enhanced tumor cell growth while also suppressing cell apoptosis. However, overexpression of miR-106a-5p had the opposite effects. In addition, rescue experiments confirmed that overexpression of VCAN-AS1 inhibited the tumor-suppressive effects mediated by miR-106a-5p. Mechanistically, through bioinformatics analysis, we found that VCAN-AS1 functions as a competitive endogenous RNA (ceRNA) of miR-106a-5p, which targets the 3' untranslated region (UTR) of signal transducer and activator of transcription 3 (STAT3). Further experiments indicated that miR-106a-5p downregulated the STAT3/hypoxia-inducible factor-1alpha (HIF-1α) pathway, while activating the STAT3 pathway reversed miR-106a-5p-mediated antitumor effects. Collectively, our data suggest that VCAN-AS1 is upregulated in breast cancer and promotes its progression by regulating the miR-106a-5p-mediated STAT3/HIF-1α pathway. This study provides a new target for BC therapy.
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http://dx.doi.org/10.1080/21655979.2021.1960774DOI Listing
December 2021

Association of lncRNA polymorphisms with cancer susceptibility: a meta-analysis of the current literature.

J Genet 2021 ;100

Department of General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi, People's Republic of China.

Considerable studies exploring the relevance of single-nucleotide polymorphisms (SNPs) in the prostate cancer noncoding RNA 1 () gene with various cancer susceptibilities have obtained debatable results. This meta-analysis was performed to precisely assess this association. Relevant published studies were selected by retrieving studies from PubMed, Embase, Web of Science, CNKI and Chinese Wanfang databases. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were applied to evaluate the strength of polymorphisms correlated with cancer susceptibility. A total of 12 articles, containing 40 independent case-control studies and seven SNPs (rs1016343, rs13252298, rs16901946, rs7007694, rs1456315, rs13254738 and rs7463708), were ultimately included in our meta-analysis. Summary results revealed a significant association with an increased overall risk of cancer for the rs1016343 C>T polymorphism (T vs C: OR=1.19, 95% CI=1.02-1.39; TT+CT vs CC: OR= 1.25, 95% CI=1.05-1.49) and rs16901946 A>G polymorphism (G vs A: OR=1.17, 95% CI=1.09-1.27; GG+AG vs AA: OR=1.20, 95% CI=1.09-1.32). Moreover, evidence of the rs13252298 A>G polymorphism correlation with decreased overall risk of cancer was observed (GG vs AG+AA: OR=0.78, 95% CI =0.67-0.92). Subgroup analyses by cancer type and ethnicity also revealed that the rs1016343 C>T polymorphism was linked with an increased risk of prostate cancer and Caucasians, respectively. The rs13252298 A>G polymorphism was correlated with a decreased risk of colorectal cancer and prostate cancer. The rs16901946 A>G polymorphism was related to an increased risk of gastric cancer and colorectal cancer in Asians. Additionally, the rs13254738 A>C polymorphism was correlated with reduced cancer risk in Asians. No correlations were discovered with cancer risk in rs7007694 T>C, rs7463708 T>G, and rs1456315 A>G polymorphisms. In summary, our meta-analysis indicates that rs1016343, rs16901946 and 13252298 polymorphisms are associated with cancer susceptibility. Further large-scale studies are required to certify our findings.
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August 2021

Systematic Review and Meta-analysis of Laparoscopic Common Bile Duct Exploration in Patients With Previous Failed Endoscopic Retrograde Cholangiopancreatography.

Surg Laparosc Endosc Percutan Tech 2021 May 11;31(5):654-662. Epub 2021 May 11.

Department of General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.

Background: The aim was to compare the outcomes of laparoscopic common bile duct exploration (LCBDE) after failed endoscopic retrograde cholangiopancreatography (group A) versus primary LCBDE (group B) for the management of gallbladder and common bile duct stones.

Materials And Methods: A comprehensive and systematic literature search was performed in several databases, including PubMed, Ovid, and Cochrane Library. Meta-analysis of operative outcomes, postoperative outcomes, and gallstone clearance rates was conducted using random-effect models.

Results: Six studies including 642 patients (239 in group A and 403 in group B) were included. The operative time was longer in group A (P=0.02). The overall complication, bile leakage, conversion, postoperative hospital stay, and reoperation were comparable in group A and group B. Similarly, no significant difference was present concerning the incidence of stone clearance, residual stone, and recurrent stone (P>0.05).

Conclusion: LCBDE is an alternative acceptable procedure when removal of common bile duct stones by endoscopic therapy fails.
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http://dx.doi.org/10.1097/SLE.0000000000000949DOI Listing
May 2021

Efficacy and safety of Seprafilm for preventing intestinal obstruction after gastrointestinal neoplasms surgery: a systematic review and meta-analysis.

Acta Chir Belg 2021 Feb 21;121(1):1-15. Epub 2021 Jan 21.

Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China.

Objective: It was controversial that hyaluronate-carboxy-methylcellulose-based membrane (Seprafilm) could prevent intestinal obstruction after gastrointestinal neoplasms operation. This study aimed to evaluate the efficacy and safety of Seprafilm in preventing postoperative intestinal obstruction of gastrointestinal neoplasms patients.

Methods: A systematic research of multiple databases was performed to identify relevant studies, and the studies satisfying the inclusion criteria were included. Risk ratio (RR), weighted mean difference (WMD), and 95% confidence intervals were calculated using RevMan 5.3.

Results: 2937 patients from 10 studies who were enrolled in this meta-analysis were divided into the Seprafilm group ( = 1334) and the control group ( = 1603). The Seprafilm group had lower incidence of intestinal obstruction (RR, 0.52; 95% CI, 0.38-0.70; < .0001), reoperation rates due to intestinal obstruction (RR, 0.48; 95% CI, 0.28 - 0.80; = .005), incidence of overall complications (RR, 0.77; 95% CI, 0.61-0.97; = .03) and higher serum creatinine on postoperative day 5 (WMD, 0.15; 95% CI, 0.05-0.25; = .003). There were no differences regarding time to intestinal obstruction after operation, aspartate aminotransferase, alanine aminotransferase, blood urea nitrogen, white blood cell count results on day 5 and 7, serum creatinine on day 7, hospital stay, and incidence of intra-abdominal infection, wound infection, anastomotic leakage between the 2 groups.

Conclusions: This meta-analysis provided valuable evidence-based support for the efficacy and safety of Seprafilm in preventing postoperative intestinal obstruction of gastrointestinal neoplasms patients. However, more multicenter randomized controlled trials from different countries are needed.
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http://dx.doi.org/10.1080/00015458.2020.1871286DOI Listing
February 2021

Minimally Invasive Pancreaticoduodenectomy in Elderly Patients: Systematic Review and Meta-Analysis.

World J Surg 2021 Apr 17;45(4):1186-1201. Epub 2021 Jan 17.

Department of General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi, China.

Background: Minimally invasive pancreaticoduodenectomy (MIPD) for pancreatic head or periampullary lesions is being utilized with increasing frequency. However, few data are available for the elderly. The objective of this study is to assess the safety and feasibility of MIPD in elderly population, by making a comparison with conventional open pancreaticoduodenectomy (OPD) and with non-elderly population.

Methods: We conducted a systematic search to identify all eligible studies in Cochrane Library, Ovid, and PubMed from their inception up to April 2020.

Results: Seven retrospective studies involving 2727 patients were included. Of these, 3 compared MIPD and OPD in elderly patients, 2 compared MIPD in elderly and non-elderly patients, and 2 included both outcomes. Compared to those with OPD, elderly patients who underwent MIPD were associated with less 90-day mortality (OR 0.56, 95% CI 0.32-0.97; P = 0.04) and fewer delayed gastric emptying (OR 0.54, 95% CI 0.33-0.88; P = 0.01). On the other hand, no significant difference was observed in terms of 30-day mortality, major morbidity, postoperative pancreatic fistula (grade B/C), postoperative hemorrhage, reoperation, 30-day readmission, and operative time. For patients who have treated with MIPD, elderly did not reveal worse outcomes than non-elderly.

Conclusion: MIPD is a safe and feasible procedure for select elderly patients if performed by experienced surgeons from high-volume pancreatic surgery centers. However, further randomized studies are required to confirm this.
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http://dx.doi.org/10.1007/s00268-020-05945-wDOI Listing
April 2021

Laparoscopic common bile duct exploration for patients with a history of prior biliary surgery: a comparative study with an open approach.

ANZ J Surg 2021 03 28;91(3):E98-E103. Epub 2020 Dec 28.

Department of General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, China.

Background: Laparoscopic common bile duct exploration (LCBDE) is increasingly being used to treat choledocholithiasis. However, few studies have examined the treatment of recurrent common bile duct stones (CBDS) in patients with a history of prior biliary surgery. The current research aimed to compare the outcomes of laparoscopic versus open common bile duct exploration in patients with a history of prior biliary surgery.

Methods: Between March 2010 and August 2019, 162 patients with recurrent CBDS after prior biliary surgery who underwent surgical management in our institution were enrolled in this study. The demographic, intraoperative and postoperative data were retrospectively analysed.

Results: Among these 162 patients, 72 underwent laparoscopic approach (LCBDE group), and 90 underwent open surgery (open common bile duct exploration group). The LCBDE group was associated with significantly lower overall complication rate, incision infection rate and blood loss compared to open common bile duct exploration group (all P < 0.05). Moreover, the laparoscopic approach significantly reduced the length of postoperative hospital stay (P < 0.05). However, the operative time, stone clearance rate, and stone recurrence rate were not significantly different between the two groups (P > 0.05). The conversion rate of the laparoscopic approach was 6.9%.

Conclusions: LCBDE is superior to open procedure in terms of blood loss, hospital stay, overall complication and incision infection in patients with a history of prior biliary surgery, and it should be considered as a safe and effective treatment if it is performed by an experienced surgeon.
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http://dx.doi.org/10.1111/ans.16529DOI Listing
March 2021

Closure of Choledochotomy With a Barbed Absorbable Suture After Laparoscopic Common Bile Duct Exploration.

Am Surg 2020 Dec 22:3134820982861. Epub 2020 Dec 22.

Department of General Surgery, 117970The First Affiliated Hospital of Nanchang University, Nanchang, JX, China.

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http://dx.doi.org/10.1177/0003134820982861DOI Listing
December 2020

Laparoscopic common bile duct exploration versus intraoperative endoscopic retrograde cholangiopancreatography in patients with gallbladder and common bile duct stones: a meta-analysis.

Surg Endosc 2021 03 6;35(3):997-1005. Epub 2020 Oct 6.

Department of General Surgery, The First Affiliated Hospital of Nanchang University, No.17 Yongwai Zhengjie, Nanchang, 330006, Jiangxi, China.

Background: To compare the efficacy and safety of laparoscopic common bile duct exploration plus laparoscopic cholecystectomy (LCBDE + LC) with intraoperative endoscopic retrograde cholangiopancreatography plus laparoscopic cholecystectomy (IO-ERCP + LC) for the treatment of gallbladder and common bile duct (CBD) stones.

Methods: We searched PubMed, Ovid, and Cochrane Library from their inception dates to April 2020, for studies that compared the efficacy and safety of LCBDE + LC with those of IO-ERCP + LC in patients with gallbladder and CBD stones. The technical success, morbidity, major morbidity, biliary leak, postoperative pancreatitis, conversion, retained stones, operative time, and postoperative hospital stay were compared between these two approaches.

Results: Five randomized controlled trials involving 860 patients were evaluated. Overall, no significant difference was found between LCBDE + LC and IO-ERCP + LC regarding technical success, morbidity, major morbidity, and the conversion rate. Biliary leak and retained stones were significantly more prevalent in the LCBDE + LC group, while postoperative pancreatitis was significantly more prevalent in the IO-ERCP + LC group.

Conclusions: LCBDE + LC and IO-ERCP + LC have similar efficacy and safety in terms of technical success, morbidity, major morbidity, and conversion rate. However, LCBDE + LC is associated with a higher biliary leak rate, lower postoperative pancreatitis rate, and higher rate of retained stones.
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http://dx.doi.org/10.1007/s00464-020-08052-yDOI Listing
March 2021

Laparoscopic common bile duct exploration for elderly patients with choledocholithiasis: a systematic review and meta-analysis.

Surg Endosc 2020 04 3;34(4):1522-1533. Epub 2020 Feb 3.

Department of General Surgery, The First Affiliated Hospital of Nanchang University, No.17 Yongwai Zhengjie, Nanchang, 330006, Jiangxi Province, China.

Background: Laparoscopic common bile duct exploration (LCBDE) has been becoming more and more popular in patients with symptomatic choledocholithiasis. However, the safety and effectiveness of LCBDE in elderly patients with choledocholithiasis is still uncertain. This meta-analysis is aimed to appraise the safety and feasibility of LCBDE for elderly patients with choledocholithiasis.

Materials And Methods: Studies comparing elderly patients and younger patients who underwent LCBDE for common bile duct stone were reviewed and collected from the PubMed, Medline, EMBASE, and Cochrane Library. Primary outcomes were stone clearance rate, overall complication rate, and mortality rate. Secondary outcomes were operative time, conversion rate, pulmonary complication, bile leakage, reoperation, residual stone rate, and recurrent stone rate.

Results: Nine studies, including two prospective studies and seven retrospective studies, met the inclusion criteria. There were 2004 patients in this meta-analysis, including 693 elderly patients and 1311 younger patients. There was no statistically significant difference between elderly patients and younger patients regarding stone clearance rate (OR 0.73; 95% CI 0.42-1.26; p = 0.25), overall complication rate (OR 1.31; 95% CI 0.94-1.82; p = 0.12), and mortality rate (OR 2.80; 95% CI 0.82-9.53; p = 0.10). Similarly, the operative time, conversion rate, bile leakage, reoperation, residual stone rate, and recurrent stone rate showed no significant difference between two groups (p > 0.05). While elderly patients showed high risk for pulmonary complication (OR 4.41; 95% CI 1.78-10.93; p = 0.001) compared with younger patients.

Conclusion: Although there is associated with higher pulmonary complication, LCBDE is still considered as a safe and effective treatment for elderly patients with choledocholithiasis.
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http://dx.doi.org/10.1007/s00464-020-07394-xDOI Listing
April 2020

The role of central pancreatectomy in pancreatic surgery: a systematic review and meta-analysis.

HPB (Oxford) 2018 10 7;20(10):896-904. Epub 2018 Jun 7.

Department of General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, China.

Background: The aim of this systematic review and meta-analysis was to compare the clinical outcomes of central pancreatectomy (CP) with distal pancreatectomy (DP) and pancreaticoduodenectomy (PD).

Methods: A systematic literature research in PubMed/Medline, Embase and Cochrane Library was performed to identify articles reporting CP from January 1983 to November 2017.

Results: Fifty studies with 1305 patients undergoing CP were identified. The overall morbidity, mortality, pancreatic fistula (PF) rate and reoperation rate was 51%, 0.5%, 35% and 4% respectively. Endocrine and exocrine insufficiency were occurred in 4% and 5% of patients after CP. Meta-analysis of CP versus DP favored CP with regard to less blood loss (WMD = -143.4, P = 0.001), lower rates of endocrine (OR = 0.13, P < 0.001) and exocrine insufficiency (OR = 0.38, P < 0.001). CP was associated with higher morbidity and PF rate. In comparison with PD, CP had a lower risk of endocrine (OR = 0.14, P < 0.001) and exocrine insufficiency (OR = 0.14, P < 0.001), but a higher PF rate (OR = 1.6, P = 0.015).

Conclusions: CP maintains pancreatic endocrine and exocrine function better than DP and PD, but is associated with a higher PF rate.
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http://dx.doi.org/10.1016/j.hpb.2018.05.001DOI Listing
October 2018

Laparoscopic common bile duct exploration in patients with previous upper abdominal surgery.

Surg Endosc 2018 12 4;32(12):4893-4899. Epub 2018 Jun 4.

Department of General Surgery, The First Affiliated Hospital of Nanchang University, No. 17 Yongwai Zhengjie, Nanchang, 330006, Jiangxi, China.

Background: Although patients with previous upper abdominal surgery are no longer considered as a contraindication in laparoscopic surgery, laparoscopic common bile duct exploration (LCBDE) for these patients is still controversial. The aim of this study was to evaluate the safety and effectiveness of LCBDE for patients with previous upper abdominal surgery.

Methods: Two hundred and seventeen patients with common bile duct stones who underwent LCBDE in our institution from January 2010 to September 2017 were enrolled in the retrospective study. They were divided into two groups: group A, with previous upper abdominal surgery (n = 50) and group B, without previous upper abdominal surgery (n = 167). Patients' demographic, intraoperative, and postoperative outcomes were retrospectively analyzed.

Results: Group A exhibited a longer operative time compared to group B (179.7 ± 61.5 vs. 156.0 ± 46.8 min, p = 0.014). There was no significant difference in intraoperative blood loss (123.9 ± 99.5 vs. 99.5 ± 84.7 mL, p = 0.087), postoperative hospital stay (7.4 ± 2.6 vs. 6.8 ± 2.3 d, p = 0.193), and overall complication rate (8.0 vs. 5.4%, p = 0.732) between the two groups. There was no mortality in both groups. The initial stone clearance rate showed no significant difference between the two groups (98.0 vs. 98.2%, p = 1.000), and the final stone clearance rate was 100% in both groups (p = 1.000). The stone recurrence rate had no significant difference between the two groups (2.0 vs. 2.4%, p = 1.000). The conversion rate was comparable between group A and group B (6.0 vs. 4.8%, p = 0.718).

Conclusions: LCBDE is a safe and feasible procedure for patients with previous upper abdominal surgery. The keys of this procedure are carefully separating the adhesions and clearly exposing the common bile duct, and using a variety of methods to remove the stones.
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http://dx.doi.org/10.1007/s00464-018-6248-3DOI Listing
December 2018

Role of surgical treatment for hepatolithiasis-associated intrahepatic cholangiocarcinoma: A retrospective study in a single institution.

J Cancer Res Ther 2017 ;13(5):756-760

Department of General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.

Context: The extent of hepatectomy and lymph node dissection (LND) in the treatment of hepatolithiasis-associated intrahepatic cholangiocarcinoma (HL-iCCA) is still controversial.

Aims: The aim of this retrospective study was to evaluate the role of surgical treatment for HL-iCCA.

Methods: The clinical data of 63 patients with HL-iCCA who undergoing surgery between January 2005 and December 2015 were analyzed retrospectively.

Statistical Analysis Used: All data were analyzed by the SPSS 17.0 software program (IMB Inc., Chicago, IL, USA). Survival curves were analyzed by the Kaplan-Meier method and compared by the Log-rank test. A P < 0.05 was considered statistically significant.

Results: Forty-nine patients (77.8%) underwent surgical resection including 35 with LND and 14 without LND. The overall 1-, 3-, and 5-year survival rates were 58.1%, 28.2%, and 10.6%, respectively, and the median survival time was 19 months. The 1-, 3-, and 5-year survival rates of resection group were 78.9%, 36.3%, and 13.5%, respectively, while the 1-year survival rate of exploratory laparotomy group was 0 (P < 0.0001). The 1-, 3-, and 5-year survival rates of patients with LND were significantly superior to those of without LND (75.9%, 39.4%, and 20.2% vs. 71.4%, 17.9%, and 0, P = 0.043). According to the N status, the 1-, 3-, and 5-year survival rates of pN0 subgroup were 81.8%, 49.2%, and 28.1%; pN1 subgroup were 65.3%, 18.6%, and 0%; and pNx subgroup were 71.4%, 17.9%, and 0%, respectively (pN0 vs. pN1, P = 0.005; pN0 vs. pNx, P = 0.004; pN1 vs. pNx, P = 0.653). The 1-, 3-, and 5-year survival rates of R0 resection (n = 42) were 80.2%, 36.7%, and 14.9%, respectively, and those of R1 resection (n = 7) were 71.4%, 0%, and 0%, respectively (P = 0.028).

Conclusions: Radical resection is the most effective therapy for HL-iCCA. Regional lymphadenectomy is strongly recommended in resectable HL-iCCA, which is helpful in tumor staging and long-term survival.
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http://dx.doi.org/10.4103/jcrt.JCRT_356_17DOI Listing
August 2018

Laparoscopic left-sided hepatectomy for the treatment of hepatolithiasis: A comparative study with open approach.

Int J Surg 2017 Apr 28;40:117-123. Epub 2017 Feb 28.

Department of General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, 330006, China. Electronic address:

Background: Hepatolithiasis is a prevalent disease in some regions of China. Left-sided hepatectomy is an effective treatment for left intrahepatic bile duct stones with irreversible disease, such as biliary strictures, severe parenchymal fibrosis or atrophy. However, the advantages of laparoscopic left-sided hepatectomy (LLH) over open approach (OLH) are still controversial. The aim of this study was to compare the clinical outcomes of LLH to those of OLH in the treatment of hepatolithiasis.

Methods: Between January 2013 and October 2016, 75 consecutive patients with hepatolithiasis undergoing left-sided hepatectomy were enrolled in this study. The demographic, intraoperative, and postoperative data were retrospectively analyzed.

Results: Among these 75 patients, 36 underwent LLH (LLH group) and 39 underwent OLH (OLH group). The LLH group exhibited a lower intraoperative blood loss (215.8 ± 75.8 vs 298.7 ± 158.9 mL, p = 0.005), intraoperative transfusion (5.6% vs 23.1%, p = 0.032), overall complication rate (13.9% vs 35.9%, p = 0.029), and shorter recovery of bowel movement (2.3 ± 0.8 vs 3.0 ± 1.0 d, p = 0.004), time of off-bed activities (3.2 ± 1.1 vs 5.8 ± 1.4 d, p < 0.001) and postoperative hospital stay (7.7 ± 2.2 vs 10.9 ± 3.3 d, p < 0.001) compared to the OLH group. Similar results were also observed in left lateral sectionectomy and hemihepatectomy subgroups. There was no significant difference in the operative time, initial stone clearance rate, final stone clearance rate, stone recurrence rate and overall cost (All p > 0.05). No perioperative mortality was observed. The conversion rate was 5.6%.

Conclusion: LLH is a safe and effective treatment for selected patients with hepatolithiasis, with an advantage over OLH in the field of intraoperative blood loss, intraoperative transfusion, overall complication and postoperative recovery.
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http://dx.doi.org/10.1016/j.ijsu.2017.02.068DOI Listing
April 2017
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